What is mesh (also known as transvaginal mesh)?
Transvaginal mesh is a net-like implant that has been used to treat pelvic organ prolapse and stress urinary incontinence in women. Most surgical mesh cleared for vaginal procedures is composed of synthetic polypropylene. This substance remains in your body once placed and does not get absorbed.
What has mesh been used to treat?
Mesh has been used in both the treatment of pelvic organ prolapse and stress urinary incontinence. When mesh is used in the treatment of stress urinary incontinence, it involves the placement of a strip of mesh called a sling around the urethra (tube from the bladder) to hold it in place. In general, larger pieces of mesh are used in the treatment of pelvic organ prolapse to reinforce weakened pelvic support structures.
Recently, the Food and Drug Administration has appropriately drawn attention to mesh related complications. Although some of the kits that have been used to treat pelvic organ prolapse are no longer available, many are still available and used. Mesh reinforcement remains helpful in some cases. For example, patients who have developed prolapse again after a prior repair might be good candidates for mesh to add extra strength to their repair. The decision to use mesh in vaginal surgery should be made by each patient after a careful discussion with your physician about the risks and benefits. Because of potential complications following mesh surgery, regular checkups with your physician are recommended if you have undergone transvaginal mesh surgery.
What are some symptoms of mesh complications?
- Pain with sexual intercourse
- Chronic pelvic pain
- Vaginal discharge
- Vaginal bleeding
- Scarring of the vagina
- Recurrent bladder infections
- Blood in the urine
- Stinging and burning when you urinate
- Recurrent leakage of urine
How often do Mesh complications occur?
If mesh is used to treat pelvic organ prolapse about 10% of patients will have a mesh erosion (mesh that wears through (“erodes”) tissue and becomes exposed, also called exposure, extrusion or protrusion) within a year of surgery.
However, if mesh is used to treat stress incontinence, the incidence of mesh complications was reported to be lower, at about 4% (or 1 in 25 patients) after 2 years. This was studied in a large trial call the TOMUS trial.
How do you make a diagnosis of mesh complication?
Taking a detailed history, performing complete focused physical examination, and ordering the appropriate tests.
What test may be ordered?
A urine sample will be taken – looking for blood or infection. We may need to use a cystocope (a fiberoptic scope) to look into bladder to make sure there is no mesh in the urinary tract – this is a quick office based procedure. An ultrasound might be used to establish the position of the mesh. If you have leakage of urine as a symptom a test called urodynamics may be needed to help define the type of leakage you have.
How is a mesh complication treated?
It maybe treated with a combination of physical therapy, use of local estrogen cream injection therapy and/or surgical removal of the mesh.
Further information on mesh complications:
Urogynecologic Surgical Mesh: Update on the Safety and Effectiveness of Transvaginal Placement for Pelvic Organ Prolapse http://www.fda.gov/downloads/medicaldevices/safety/alertsandnotices/ucm262760.pdf
Position Statement on Mesh Midurethral Slings for Stress Urinary Incontinence from AUGS and SUFU http://www.sufuorg.com/docs/news/AUGS-SUFU-MUS-Position-Statement-APPROVED-1-3-2014.aspx